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Neeraja et al. World Journal of Pharmaceutical Research
CLINICAL STUDY WITH KANAJATA (PIPER LONGUM LINN. ROOT)
AND ITS EFFECT ON POSTNATAL ABDOMINAL BULKINESS IN
WOMEN
D. S. N. V. Neeraja* and Dr. M. Paramkusha Rao
Department of Dravyguna, S.V. Ayurvedic Medical College, Tirupati.
ABSTRACT
Ayurveda is the science of life. Ayurveda elucidate due importance for
the care of mother at every phase of her life especially to the antenatal
and post natal care. After delivery mother has to take care of her baby
along with her own health care. Puerperium is a period following child
birth which can be certainly co-related with Sutika paricharya
explained in Ayurveda. In this period many changes occurs in the body
physiologically and anatomically to regain the prepregnancy state.
Mithyachaara – inappropriate physical and mental behaviour in this
period definitely results in incurable diseases. Now-a-days many
women are facing problem with acquired bulkiness and post natal
weight retention. The main reason for this bulkiness is mismanagement after delivery.
Conventional care of delivered women is missing. After delivery women has to follow certain
dietetic rules. Ancient Acharyas mentioned certain drugs like pippali, Pippalimula, Nagara,
Chavya etc. and diet for the delivered women. These drugs help in the Dushtasonita sudhi
(purification of the blood), Vatasamsamana and makes the body to attain the prepregnancy
status.
KEYWORDS: Ayurveda, Puerperium, Sutika paricharya, Mithyachara, Postnatal weight
retention.
INTRODUCTION
Reproductive age is the important period in woman’s life. In this life stage women have to
undergo much ebb and flow of which decides her health in the next life stage after 40’s.
Delivery is the re-birth for women. After delivery, care of newborn as well as mother is
World Journal of Pharmaceutical Research SJIF Impact Factor 6.805
Volume 5, Issue 9, 1821-1840. Research Article ISSN 2277– 7105
*Corresponding Author
D. S. N. V. Neeraja
Department of Dravyguna,
S.V. Ayurvedic Medical
College, Tirupati.
Article Received on
22 July 2016,
Revised on 12 August 2016,
Accepted on 02 Sep. 2016
DOI: 10.20959/wjpr20169-7054
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equally important to come back to normal lifestyle, overcoming all physiological and
behavioural changes.
After delivery many women are unable to lose the weight gained during pregnancy. It’s every
woman’s dream to lose all the extra pregnancy pounds the moment baby finally arrives. It is a
burning problem and is a challenge for women to take care of body to attain to prepregnant
state. Pregnancy is a complicated period for women in that it is often the first time weight
gain is expected and accepted. Pregnancy-related weight gain has emerged as a potential
cause of increased adiposity.
In Observational epidemiological studies, the average weight change from preconception to
the first year postpartum is referred to as “Postpartum weight retention.” Postpartum weight
retention includes the weight gain during gestation (Preconception through gestation), early
postpartum weight loss (delivery to 6 weeks postpartum), later postpartum weight changes
after 6 weeks postpartum).[1]
Excess weight retention is increasingly common after pregnancy, a recognized high risk
period for weight gain, with 56% of pre-existing overweight and obese women gaining
beyond the recommendations of International Institute of Medicine recommendations for
gestational weight gain(GWG).[2]
Weight gain and overweight during midlife are strong
independent predictors of cardiovascular disease, particularly among women. It is also may
cause the metabolic syndrome, type 2 diabetes and early mortality.[3]
Postnatal care is a period following child birth which can be certainly co-related with Sutika
paricharya explained in Ayurveda.[4]
Intervening to reduce postpartum weight retention is
important public health initiative; however key gaps remain. The postnatal period represents
a prime opportunity to educate women from all economic backgrounds about proper
nutrition, exercise and the benefits of maintaining a healthy lifestyle. So this is the time to
support this challenging problem of women by the intervention through the treatment as
measure to control.
In folklore it is a common practice to use certain appetizing drugs along with jaggery in
delivered cattle for regaining the normal health and to control the infections.
In certain areas of Andhra Pradesh a spicy powder or chutney (a food recipe) is prepared and
specially given to new mother to maintain the health. The recipe consists of Piper longum.
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Therefore we have selected as the main drug Kanajata (Piper longum Linn. root) in the
present study to prove clinically it as an effective medicine.
वदृ्ध् |
||(B.P. S Yoniroga.Ci.70).
The main reference of the study is in Bhavaprasha samhita belongs to 16th century,
Yonirogadhikaara, Prasuti Cikitsa, Kanajata (Piper longum Linn. root) is advised to take with
Madhita takra for 21 days in the retention of abdominal bulkiness after delivery.[5]
So
Kanajata (Pippalimula) is selected for the present study in the management of Postnatal
abdominal bulkiness in women.
AIMS AND OBJECTIVES
1. To study the effect of Kanjata with takra in the Abdominal bulkiness in women.
2. To study the effect of Kanajata with Guda in the Abdominal bulkiness in women.
3. To study the effect of Placebo (Wheat powder) in the Abdominal bulkiness in women.
4. Comparative effect of the Kanajata and Placebo in the Abdominal bulkiness in women.
MATERIALS AND METHODS
This study was a randomized placebo control study carried out in Sri Venkateshwara
Ayurvedic Hospital, Tirupati, Chittor District. Women suffering from Abdominal bulkiness
from 1 year delivery.
Data was collected using a clinical proforma consisted of the Name, age, educational status,
duration of illness, associated illness, complications during delivery.
(1) Women suffering from Abdominal bulkiness were selected on the basis of
symptomatology with body dissatisfaction, BMI>25, waist and hip circumferences higher
than the recommended levels.
(2) Patients attending Out Patient Department of S.V Ayurvedic hospital, Tirupati, were
selected randomly irrespective of their caste, religion, occupation.
INCLUSION CRITERIA
Age group of 22 yrs to 40 yrs married women.
Women delivered 1 yr before and having bulkiness of abdomen.
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EXCLUSION CRITERIA
Women having bulkiness of abdomen due to endometriosis.
Age group below 22 yrs and greater than 40 yrs.
Women suffering from cervical carcinoma, evidence of renal, hepatic, spleen and cardiac
involvement.
High blood pressure, high glucose levels.
Patients with long term steroid treatment.
Women with hypothyroidism, Cushing's syndrome and growth hormone deficiency.
Subjective Parameters of the Study
Grouping and Sampling
Group 1 KJT: Finely powdered Pippalimula is made into capsules 250mg and is given to the
patient and advised to take 2 capsules twice a day along with Takra as anupana.
Group 2 KJG: Finely powdered Pippalimula is pounded along with jaggery is made into
capsules of 250mg and is given to the patients 2 capsules twice a day.
Group 3 WT: Placebo(Wheat powder) is made into 250mg capsules and is given to the
patients.
Investigations
Routine Pathological tests such as blood, urine, ESR etc., has been carried out to assess the
actual status of patients and to rule out any pathology.
Criteria of Assessment
Subjective assessment criteria
The symptoms that are assessed in patients are:
1. Chala Sphika Udara Stana
2. Kshudra Swasa / Ayasena Swasa Kastata
3. Alasya/ Utshaha hani
4. Daurbalyata (Alpa Vyayam)
5. Nidradhikya
6. Daurgandhata
7. Atipipasa
8. Atikshuda
9. Anga Gaurava (heaviness in body)
10. Vyavaya Kasta
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11. Svedadhikyata
Scoring pattern of Subjective Parameters
1) Chala Sphika Udara Stana
Grade 1 – No presence of Chalatwa
Grade 2 - Little visible movement after fast movement
Grade 3 - Little visible movement after moderate movement
Grade 4 - Movement after mild movement
Grade 5 - Movement even after changing posture
2) Kshudra Swasa / Ayasena Swasa Kastata
Grade 1 Dysponea after heavy work but relieved soon & Up to tolerance
Grade 2 - Dysponea after moderate work but relieved late & Up to tolerance
Grade 3 - Dysponea after little work but relieved soon & Up to tolerance
Grade 4 - Dysponea after little work but relieved soon & beyond tolerance
Grade 5 - Dysponea in resting condition
3) Alasya/ Utshaha hani
Grade 1 –Absence of Alasya
Grade 2 - Doing work satisfactory with initiation late in time
Grade 3 - Doing work unsatisfactory with lot of mental pressure & late in time
Grade 4 - Not starting any work in his own responsibility, doing little work very slow
Grade 5 - Does not have any initiation & not wants to work even after pressure
4) Daurbalyata (Alpa Vyayam)
Grade 1 - Can do routine exercise
Grade 2 - Can do moderate exercise without difficulty
Grade 3 - Can do only mild exercise
Grade 4 - Can do only mild exercise with very difficulty
Grade 5 - Can do even mild exercise
5) Nidradhikya
Grade 1 - Normal sleep 6-7 hrs/ day;
Grade 2 - Sleep upto 8hrs / day with Anga Gurav
Grade 3 - Sleep upto 8hrs / day with Anga Gurav & Jrimbha;
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Grade 4 - Sleep upto 10hrs / day with tandra;
Grade 5 - Sleep upto 10hrs / day with Tandra & Klama
6) Daurgandhata
Grade 1 - Absence of bad smell
Grade 2 - Occasionally bad smell limited to close areas difficult to suppress with deodorants
Grade 3- Persistent bad smell felt from long distance is not suppressed by deodorants
Grade 4 - Persistent bad smell felt from long distance even Intolerable to the patient himself
7) Atipipasa
Grade 1 - Normal thirst
Grade 2 - Upto 1 lit excess intake of water
Grade 3 - 1 to 2 lit excess intake of water
Grade 4 – 2 to 3 lit excess intake of water
Grade 5 - More than 3 lit intake of water
8) Atikshuda
Grade 1 - Unwilling for food but could take the meal
Grade 2 - Willing towards only most liking food & not to others
Grade 3 - Willing towards only one among Katu/ Amla / Madhura food stuffs
Grade 4 - Willing towards some specific Ahara / Rasa Vishesa
Grade 5 - Equal willing towards all the Bhojjaya padartha
9) Anga Gaurava (heaviness in body)
Grade 1 - No heaviness in body
Grade 2 - Feels heaviness in body but it does not hamper routine work
Grade 3 - Feels heaviness in body which hampers daily routine work
Grade 4 - Feels heaviness in body which hampers movement of the body
Grade 5 - Feels heaviness with flabbiness in all over body which causes distress to the person
10) Vyavaya Kasta
Grade 1 - Unimpaired libido & sexual performance
Grade 2 - Decrease in libido but can perform sexual act
Grade 3 - Decrease in libido but can perform sexual act with difficulty
Grade 4 - Loss of libido & cannot perform sexual act
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11) Swedadhikya
Grade 1 - Sweating after heavy work
Grade 2 - Sweating after little work
Grade 3 - Profuse sweating after heavy work
Grade 4 - Profuse sweating after minimum work
Grade 5 - Sweating even in resting condition
Objective Assessment
Body Mass Index (BMI) – also called Quetlet index is a value derived from mass (weight)
and height of an individual. BMI =Weight (kg) /Height (in sq.m.).[6]
1. Waist and Hip Circumference
The waist circumference should be measured at the midpoint between the lower margin
of the last palpable rib and the top of the iliac crest, using a stretch resistant tape that
provides a constant 100g tension.
Hip Circumference should be measured around the widest portion of the buttocks, with
the tape parallel to the floor.
2. Skinfold Thickness Assessment
A skinfold thickness measurement provides an estimated size of the subcutaneous fat
deposit, which is basically the fat under the skin. By estimating the thickness of this area
researchers are able to obtain an estimation of the total body fat.
In the present study Digital body fat calipers is used to estimate the skinfold thickness.
The skinfolds are measured at the 3 skinfold sites Abdominal, Suprailiac, Triceps skinfold
thicknesses.
Abdominal Skinfold
The abdominal skinfold is measured 3 cm adjacent to the umbilicus, to the right side and 1cm
inferior to it.
Pinch: The vertical pinch is made at the marked site and the calipers placed just below the
pinch. Also horizontal pinch is taken from 1cm, 2cm, 3cm from the umbilicus.
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Suprailiac Skinfold
It is measured immediately above the iliac crest (top of hip bone), on the most lateral aspect
(side) i.e., where an imaginary line come from the anterior axillary border.
Pinch: The fold is directed anteriorly and downward in line with natural fold of the skin.
The right arm should be held across the body to keep it away from the measurement area.
The Triceps skinfold
At the level of the mid-point between the acromiale (lateral edge of the acromion process, the
bony of shoulder) and the radiale (proximal and lateral border of the radius bone,
approximately the elbow joint), on the mid-line of the posterior (back) surface of the arm
over the triceps muscle.
Pinch: 1. The arm should be relaxed with the palm of the hand facing towards (supinated).
2. A vertical pinch, parallel to the long axis of the arm, is made at the landmark.
In case of all circumference measurements, the mean values were taken before and after
treatment. The body wt. was also taken before and after treatment.[8]
3. Sagittal Abdominal Diameter
Sagittal Abdominal Diameter, also referred to as “abdominal height,” has been suggested as
an alternative to measuring WC as a way to assess visceral obesity. This measurement is
taken either in supine position or standing.
SAD was measured in the supine position at the top of the iliac crest. Horizontally one scale
on the abdomen and the other vertically placed by the side of abdomen.[9]
4. Body Fat Percentage
Body fat includes essential body fat and storage body fat. Essential body fat is present in
the nerve tissues, bone mass and we cannot lose this fat without compromising
physiological function. Storage body fat consists of fat accumulation in adipose tissue,
part of which protects internal organs in the chest and abdomen.[10]
In the present study we adopted thicknesses of skinfolds which is an anthropometric
method for estimating body fat.
The Jackson-Pollock skinfold method is used to calculate body fat percentage from the
three skinfolds of abdominal, suprailiac, triceps in the study sample.
Hold button
Screen
Zero point
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Guidelines for Exercise Testing and Prescription: American College of Sports Medicine
in 2000 Female Three-site Formula[11]
, Abdomen, Suprailiac, Triceps
% Body Fat Percentage = (0.41563× sum of three skinfolds) – (0.00112 × [sum of three
skinfolds]2 ) + (0.03661 × age) + 4.03653
OBSERVATIONS
Table No: 1
S.No. Parameter No. of Patients
Total Percentage% Group 1 Group 2 Group 3
1. Chala Spik Udara
Stana 10 8 8 26 86.66
2. Kshudra Svasa 8 7 5 20 66.66
3. Alasya 5 8 6 19 63.33
4 Daurbalya 7 6 8 21 70
5 Nidradhikya 6 8 5 19 63.33
6 Daurgandhya 5 9 5 19 63.33
7 Atipipasa 7 6 6 19 63.33
8 Atikshudha 8 8 5 21 70
9 Angagaurava 9 7 6 22 73.33
10 Vyavayi Kashtata 8 8 4 20 66.66
11 Svedadhikya 8 8 7 23 76.66
Assessment of the Result
Overall percentage of improvement of each patient was calculated by the formula
% Change = Mean BT - Mean AT\ Mean BT × 100
Paired t-test was carried out at each symptom individually in three groups, whereas Anova
was applied to study the comparative results of 3 groups at the level of P<0.05, P<0.01 and
P<0.001 levels.
Insignificant: P<0.05
Significant: P<0.05
Highly Significant: P<0.01
Extremely Significant: P<0.001
Total effect of Therapies
Complete remission 100% of relief
Marked improvement 75-100% of relief
Moderate improvement 50-75% of relief
Mild improvement 25-50% relief
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OBSERVATIONS
A total of 30 patients were registered in the present study and 10 patients in each group.
Group 1 KJT
Table No: 2
In the present study 100% of the patients were suffering from the bulkiness of abdomen and
the other symptoms of medoroga.
Group 2 KJG
Table No: 3
S.No. Parameter MEAN SD SE
t Value P value Significance BT AT BT AT BT AT
1. Chala Spik Udara
Stana 1.80 0.20 0.79 0.42 0.25 0.13 9.7980 <0.001 Extremely significant
2. Kshudra Svasa 1.20 0.20 0.92 0.42 0.29 0.13 4.7434 <0.001 Extremely significant
3. Alasya 1.10 0.20 1.45 0.42 0.46 0.13 2.5861 <0.05 Statistically significant
4 Daurbalya 1.60 0.20 1.43 0.42 0.45 0.13 3.7717 <0.05 Statistically significant
5 Nidradhikya 1.50 0.20 1.51 0.42 0.48 0.13 3.2844 <0.01 Highly significant
6 Daurgandhya 1.00 0.50 1.25 0.85 0.39 0.27 3.0000 <0.01 Highly significant
7 Atipipasa 1.20 0.40 1.03 0.70 0.33 0.22 3.2071 <0.01 Highly significant
8 Atikshudha 1.50 0.70 1.08 0.82 0.34 0.26 6.0000 <0.001 Extremely significant
9 Angagaurava 2.10 0.80 1.29 0.92 0.41 0.29 6.0908 <0.001 Extremely significant
10 Vyavayi Kashtata 1.50 0.60 1.08 0.70 0.34 0.22 5.0138 <0.001 Extremely significant
11 Svedadhikya 1.90 0.70 1.20 0.67 0.38 0.21 4.8107 <0.001 Extremely significant
S.No. Parameter MEAN SD SE
t Value Pvalue Significance BT AT BT AT BT AT
1. Chala Spik Udara
Stana 1.40 0.40 1.07 0.52 0.34 0.16 4.7434 <0.001 Extremely significant
2. Kshudra Svasa 1.10 0.50 0.99 0.71 0.31 0.22 3.6742 <0.01 Highly significant
3. Alasya 1.40 0.70 1.07 1.06 0.34 0.33 4.5826 <0.001 Extremely significant
4 Daurbalya 1.20. 0.20 1.23 0.42 0.39 0.13 3.0000 <0.01 Highly significant
5 Nidradhikya 1.70 0.20 1.34 0.42 0.42 0.13 4.3916 <0.001 Extremely significant
6 Daurgandhya 1.40 0.40 0.84 0.70 0.27 0.22 6.7082 <0.001 extremely significant
7 Atipipasa 0.90 0.20 0.88 0.42 0.28 0.13 3.2796 <0.01 Highly significant
8 Atikshudha 1.50 0.30 1.08 0.48 0.34 0.15 4.1295 <0.01 Highly significant
9 Angagaurava 1.10 0.90 1.43 1.10 0.45 0.35 4.5826 <0.001 Extremely significant
10 Vyavayi Kashtata 1.30 0.50 0.95 0.53 0.30 0.17 4.0000 <0.001 Extremely significant
11 Svedadhikya 1.30 0.70 1.06 0.82 0.33 0.26 3.6742 <0.01 Highly significant
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Group 3 WT
Table No: 4
EFFECT OF THE THERAPY IN THREE GROUPS
Table No: 5
OVER ALL RESULT OF THE STUDY ACCORDING TO % OF RELIEF
Parameter % of Relief
Group-1 Group-2 Group-3
Chala Spik Udara Stana 88.89 20 71.42
Kshudra Swasa 83.33 42.97 54.55
Alasya 81.81 44.44 50
Dourbalya 87.5 47.05 83.33
Nidradhikya 86.67 42.87 88.23
Dourgandhya 50 33.33 71.42
Atipipasa 66.67 36.37 77.78
Atikshudha 53.33 27.27 80
Angagaurava 61.9 27.27 18.18
VyavayaKashtata 60 66.67 61.55
Svadadhikya 63.16 53.85 46.15
Above table shows reduction of symptoms statistically in 3 groups.
In the present study Group 1 (KJT) Kanajata with Takra maximum 88.89%(P<0.001) relief
was observed in Chala Spik Udara Stana, 83.33% (P<0.001) relief in Kshudra swasa, 87.5%
(P<0.05) relief in Dourbalya, 86.67%(P<0.01) relief in Nidradhikya, 66.67% (P<0.01) relief
in Atipipasa, 63.16%(P<0.001) relief in Svedadhikya whereas Atikshudha, Angagaurava and
Vyavayi ksashtata were reduced by 53.33%(P<0.001), 61.9%(P<0.001) and 60% (P<0.001)
respectively. Statistics of the above parameters have shown extremely significant results in
the Group 1 KJT.
S.No. Parameter MEAN SD SE
t Value Pvalue Significance BT AT BT AT BT AT
1. Chala Spik
Udara Stana 1.50 1.20 0.97 1.14 0.31 0.36 1.9640 >0.05 Insignificant
2. Kshudra Svasa 0.70 0.40 0.82 0.70 0.26 0.22 1.9640 >0.05 Insignificant
3. Alasya 0.90 0.50 0.99 0.71 0.31 0.22 2.4495 <0.05 Statistically significant
4 Daurbalya 1.70 0.90 1.34 0.88 0.42 0.28 4.0000 <0.01 Highly significant
5 Nidradhikya 0.70 0.40 0.82 0.70 0.26 0.22 1.9640 >0.05 Insignificant
6 Daurgandhya 0.90 0.60 1.10 0.84 0.35 0.27 1.9640 >0.05 Insignificant
7 Atipipasa 1.10 0.70 1.10 0.95 0.35 0.30 2.4495 <0.05 Statistically significant
8 Atikshudha 1.10 0.80 1.10 1.14 0.35 0.36 1.9640 >0.05 Insignificant
9 Angagaurava 1.10 0.80 1.10 1.14 0.35 0.36 1.9640 >0.05 Insignificant
10 Vyavayi
Kashtata 0.60 0.20 0.84 0.42 0.27 0.13 2.4495 <0.05 Statistically significant
11 Svedadhikya 1.30 0.60 1.16 0.70 0.37 0.22 3.2796 <0.01 Highly significant
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In the present study in Group 2, (KJG) Kanajata Group with Guda 71.42%(P<0.001) relief
was observed in Chala Spik Udara Stana, 54.55%(P<0.01) relief in Kshudra swasa, 83.33%
(P<0.01) relief in Dourbalya, 88.23%(P<0.001) relief in Nidradhikya, 77.78% (P<0.01) relief
in Atipipasa, 46.15%(P<0.01) relief in Svedadhikya whereas Atikshudha, Angagaurava and
Vyavayi ksashtata were reduced by 80%(P<0.01), 18.18% (P<0.001) and 61.55% (P<0.001)
respectively. Statistics of the above parameters have shown highly significant results in the
2nd
Group KJG.
In the present study Group 3 (WT) Kanajata with Takra maximum 53.85% (P<0.01) relief
was observed in Svedadhikyata, 66.67% (P>0.05) relief in Kshudra swasa, 47.05% (P<0.01)
relief in Dourbalya, 44.44%(P<0.05) relief in Alasya, 42.87% (P>0.05) relief in
Nidradhikyata, 36.37% (<0.05) relief in Atipipasa whereas Angagaurava, Chala Spik Udara
Stana and Atiskshudha were reduced by 27.27% (P>0.05), 20% (P>0.05) and 27.27%
(P>0.05) respectively. Statistics of the above parameters showed that results were
insignificant in the placebo control 3rd
Group.
OBJECTIVE PARAMETERS
Objective Parameters of the study are Body Fat Percentage, Skinfold Thickness, Body Mass
Index, Sagittal Abdominal Diameter, Waist and Hip Circumferences. The observations and
statistical analysis of the parameters are as follows.
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STATISTICAL SIGNIFICANCE OF GROUP 1 KJT
Table No: 6
STATISTICAL SIGNIFICANCE OF GROUP 2 KJT
Table No: 7
Parameter MEAN SD SE
t Value Pvalue Significance BT AT BT AT BT AT
Body Fat
Percentage 28.0132 26.0763 1.661 1.713 0.5254 0.541 11.5486 <0.001
Extremely
significant
Body Mass Index 29.267 27.629 2.8771 2.614 0.909 0.826 10.3659 <0.001 Extremely
significant
Waist
Circumference 35.95 34.81 2.171 2.201 0.687 0.696 8.0521 <0.0001
Extremely
significant
Hip
Circumference 42.370 39.430 2.152 2.340 0.680 0.740 2.9244 <0.01
Highly
significant
Abdominal
skinfold thickness 26.850 24.440 2.953 2.595 0.934 0.821 7.1139 <0.001
Extremely
significant
Suprailiac
skinfold thickness 29.450 26.760 2.718 2.575 0.859 0.814 13.2153 <0.001
Extremely
significant
Triceps skinfold
thickness 20.040 17.470 2.553 2.411 0.807 0.762 9.6367 <0.001
Extremely
significant
Parameter MEAN SD SE
t Value Pvalue Significance BT AT BT AT BT AT
Body Fat
Percentage 28.6771 27.2463 0.8127 0.6432 0.2570 0.2034 12.5337 <0.001
Extremely
significant
Body Mass Index 28.5741 27.5004 2.2708 2.7489 0.7181 0.8693 2.8524 <0.05 Statistically
significant.
Waist
Circumference 36.49 34.21 1.374 1.581 0.434 0.500 3.4417 <0.01
Highly
Significant
Hip
Circumference 43.350 41.810 1.346 1.470 0.426 0.465 2.4433 <0.05
Statistically
signifiicant
Abdominal
skinfold thickness 28.620 26.590 2.333 2.374 0.738 0.751 8.3331 <0.001
Extremely
significant
Suprailiac
skinfold thickness 30.750 28.810 1.637 1.978 0.518 0.518 7.7061 <0.001
Extremely
significant
Triceps skinfold
thickness 19.745 17.590 1.970 1.144 0.594 0.362 2.7857 <0.05
Statistically
significant
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STATISTICAL SIGNIFICANCE OF GROUP 3 WT
Table No: 8
Inter Comparison of the Groups KJT, KJG, WT by One way Anova Test
Table No. 9
Parameters f value p value Significance
Chala Spik Udara Stana 13.45 <0.001 Extremely significant
Kshudra Svasa 3.918 <0.05 Significant
Alasya 1.110 >0.05 Insignificant
Dourbalya 1.218 >0.05 Insignificant
Nidradhikya 4.180 <0.05 Significant
Dourgandhya 4.582 <0.05 Significant
Atipipasa 0.9669 >0.05 Insignificant
Atikshudha 4.858 <0.05 Significant
Angagaurava 8.241 <0.01 Highly Significant
Vyavayi Kashtata 2.744 >0.05 Insignificant
Svadadhikya 2.762 >0.05 Insignificant
Above table shows the results of single factor Anova of the parameters.
Inter Comparison of the Groups KJT, KJG, WT by One way Anova Test
Table No: 10
Parameters f value p value Significance
Body Fat Percentage 36.28 <0.001 Extremely significant
Abdominal Skinfold Thickness 12.89 <0.001 Extremely Significant
Suprailiac Skinfold Thickness 1.566 >0.05 Insignificant
Triceps Skinfold Thickness 19.39 <0.001 Extremely significant
Supine Sagittal Abdominal Diameter 67.49 <0.001 Extremely Significant
Waist Circumference 67.83 <0.001 Extremely Significant
Hip Circumference 50.70 <0.001 Extremely significant
Body Mass Index 8.760 <0.001 Extremely Significant
Above table shows the results of single factor Anova of the parameters.
Parameter MEAN SD SE
tValue Pvalue Significance BT AT BT AT BT AT
Body Fat Percentage 28.5885 28.4952 1.15118 1.2105 0.36403 0.3827 1.1914 >0.05 Insignificant
Body Mass Index 28.8541 28.7369 1.5258 1.3341 0.4825 0.4219 0.9806 >0.05 Insignificant
Waist
Circumference 36.50 36.42 2.014 2.009 0.637 0.635 0.0889 >0.05 Insignificant
Hip Circumference 43.520 43.490 1.767 1.800 0.559 0.569 0.0376 >0.05 Insignificant
Abdominal skinfold
thickness 28.990 29.000 2.049 2.086 0.648 0.660 0.0328 >0.05 Insignificant
Suprailiac skinfold
thickness 30.510 30.055 2.629 2.722 0.831 0.821 0.1579 >0.05 Insignificant
Triceps skinfold
thickness 19.060 18.800 1.350 1.427 0.427 0.451 1.7169 >0.05 Insignificant
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Effect of therapy in the three Groups
OVER ALL RESULT OF THE STUDY ACCORDING TO % OF RELIEF
Table No:
Parameter % of Relief
Group-1 Group-2 Group-3
Body Fat Percentage 6.92% 4.99% 0.31%
Abdominal Skinfold Thickness 8.98% 7.1% 0.38%
Suprailiac Skinfold Thickness 9.13% 6.31% 1.51%
Triceps Skinfold Thickness 12.82% 10.89% 1.36%
Supine Sagital Abdominal Diameter 4.51% 3.64% 0.1%
Waist Circumference 3.17% 6.24% 0.22%
Hip Circumference 6.93% 3.55% 0.06%
Body Mass Index 5.58% 3.75% 0.41%
The above table shows the overall percentage of relief in three groups. In Group 1 KJT The
reduction observed in body fat percentage was 6.92% (p<0.001), in Group 2 KJG it was
reduced by 4.99% (P<0.001) and in Group 3 reduction was 0.31% (P>0.05). The decrease
observed in Abdominal Skinfold thickness was 8.98% (P<0.001), 7.1% (P<0.001), 0.38%
(P>0.05) respectively in Group 1, Group2, Group 3 respectively. Suprailiac Skinfold
Thickness was reduced by 9.13% (P<0.001), 6.31% (P<0.001), 1.51% (P>0.05) in Group 1, 2
and 3 respectively.
There is reduction of 12.82% (P<0.001), 10.89% (P<0.05), 1.36% (P<0.05) is observed in
Triceps Skinfold Thickness in 3 Groups respectively. The reduction observed in Supine
sagittal Abdominal diameter in 3 groups was 4.51% (P<0.001), 3.64% (P<0.001), 0.1%
(P>0.05).
Waist circumference was decreased by 3.17% (P<0.001), 6.24% (P<0.01) and 0.22%
respectively in KJT, KJG and Placebo groups respectively. Reduction observed in Hip
circumference was 6.93% (P<0.01), 3.55% (P<0.05), 0.06% (P>0.05) respectively in 3
Groups. BMI was decreased by 5.58% (P<0.001) in Group 1, 3.75% (P<0.01) in Group 2 and
0.41% (P>0.05) in the placebo control Group.
Statistically all parameters showed extremely significant results in Group 1 KJT and highly
significant results in Group 2 KJG and the results were insignificant in the placebo control
group.
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Statistics representing the overall percentage of relief in 3 Groups
BFP-Body fat percentage, AST-Abdominal skinfold thickness, SST-Suprailiac skinfold
thickness, TST-Triceps skinfold thickness, SAD-supine sagittal abdominal diameter,
WC-Waist circumference, HC-Hip circumference, BMI-Body Mass Index.
DISCUSSION
Giving birth is a life transforming moment for a woman. Losing weight after pregnancy is a
Great challenge for woman in that stage. Post pregnancy abdominal bulkiness is one of the
most common complaints of new mothers. The abdomen and overall hips get enlarged due to
pregnancy and coming back to prepregnant state takes some time. During this time if care
wasn’t taken then it leads to settled abdominal bulkiness which may lead to obesity in future.
Each excess of pound is difficult to loose afterwards. So it is necessary to have proper care
during Postpartum and adapt a healthy lifestyle during Postpartum.
Postpartum obesity is very well managed during yesteryears in India. Several household
practices are observed in the society. In certain areas of Andhra Pradesh a spicy powder or
chutney (a food recipe) is prepared and specially given to new mother to maintain the health.
The recipe consists of Piper longum. So the use of Pippalimula is beneficial in prevention and
cure of Postpartum weight retention and abdominal bulkiness in women.
The various mechanisms identified for postpartum obesity are, Gestational weight gain higher
than the recommended levels may lead to postpartum weight retention in women. Gestational
weight gain above the recommended levels was associated with threefold higher risk of
becoming overweight after pregnancy (BMI≥26) among who were under or average weight
before pregnancy.[13]
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Prepregnancy weight is an attributing factor for the weight retention after delivery. Women
who are already over-weight or obese before first pregnancy tends to retain or gain more
weight after pregnancy than average weight women[13-15]
despite larger newborns[16]
and
wider variability in gestational weight gain. Weight gain before, during and after pregnancy
not only affects the current pregnancy but may also be a contributor to the future
development of obesity in women.[17-19]
Lipid metabolism in lactation, the studies in rats show that the increase in maternal fat
deposits takes place during the first 2/3rd
of the gestation are a consequence of hyperplasia
and enhanced adipose tissue lipogenisis, which is present in both humans and in rats.[20]
The
hormonal shift makes the mobilization of fat from the peripheral to the central parts of the
body during lactation where the pattern is reversed.[21]
Also the adipocyte size varies
depending on the balance between mobilizations.
Adiposity is common in pregnancy which may further increase during postpartum period
which is seen in many women. These influences may lead to a condition in which women
may become obese but metabolically in fine condition. This can be called as “Pro-obesity”
condition. In this condition there are no much metabolic disturbances but physically they are
obese in state due to the fat deposition during pregnancy. The condition may lead to future
obesity due to the modification of lifestyle which is influenced by many hormonal and
environmental factors.
Bhavamisra in Bhavaprakasha Samhita mentioned in Yonirogadhikara, Prasuti Cikitsa that
Kanajata (Pippalimula) should be taken with Madhita takra in the abdominal bulkiness for
21days to attain prepregnant state. The study is on 30 patients in 3 different Groups,
Group 1: Kanajata is given with Takra(KJT).
Group 2: Kanajata and jaggery is given (KJG).
Group 3: Placebo (Wheat powder). Pippalimula is effective when given with takra. Takra
possess kashaya and amla rasa. It is kaphavatahara and laghu in digestion and improves the
digestion by deepana property. So pippalimula along with takra is more effective.
Group1 patients have shown better results when compared to other 2 Groups. On Comparing
Group 2 Kanajata with Guda with 3rd
Group (Placebo) better results are observed. In the
subjective parameters Chala Spik Udara Stana, Kshudra svasa, Alasya, Dourbalya,
Angagaurava, Svedadhikya Kanjata with Takra group shown marked improvement whereas
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Kanjata with Guda shown moderate improvement. Nidradhikya, Dourgandhyata, Atipipasa,
Atikshudha, Vyavayi kashtata Kanjata with Guda group shown marked improvement
whereas Kanjata with Takra shown moderate improvement and there was minimal effect
found in placebo group.
In Objective parameters Body fat Percentage, Body Mass Index, Waist Hip Ratio, Abdominal
skinfold thickness, Suprailiac skinfold thickness, Triceps skinfold thickness Kanajata with
Takra group shown marked improvement, Kanajata with Guda shown moderate improvement
and minimal improvement in Placebo group.
Probable mode of action of Pippalimula
Pippalimula having Katu Rasa, laghu, Ruksha guna causes Kleda soshana[22]
; Ushna guna
causes the Ama pachana; Tikshna gunaa causes the Kapha chedana and Lekhana of
Medoavarana in srotas. By removing the kaphavarodha the Medoavrita vata is relieved
which makes the samasthiti of Jataragni and Medodhatvagni.
Piperine, a Piperidine derivative is the main active principle in the piper longum Linn.
Roots and fruits which acts as a melanocyte 4 receptor agonists which is the probable
mode of action for the decrease in the Postpartum weight retention and abdominal
bulkiness in women.
By the increase in MC-4 activity helps in reduction of adiposity (obesity) and its related
metabolic syndromes like dyslipidemia. Melanocortin activity may also be increased by
an endogenous inhibition of inverse agonists (agoulti-related peptide) of melanocortin
receptors. Piperidine, piperazine etc., are the MC4 agonists which help in reduction of
adiposity.[23]
CONCLUSION
Ayurveda has a greater potential to correct these lifestyle disorders. Postpartum bulkiness of
women is a lifestyle disorder. Hence in this study an effort has been made to work out a
convenient single herbal drug to combat the current problem.
Kanajata stands as an appropriate medication and is found very promising in the study. It has
been noticed that the practice of Prenatal and Postnatal care are being in practiced by the
women in the Indian society since long time. Losing the pounds after delivery is becoming a
task nowadays which interferes her health and married life. So it is necessary for the new
mothers to take care about the weight gaining during delivery and postnatal care mentioned in
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Ayurvedic care along with traditional care in the communities is to be followed without
missing. This makes the healthy women society preventing the afterward effects of the excess
weight gained after the pregnancy.
Pippalimula having Laghu, Ruksha and Ushna properties and kledasoshana, medohara action
is very beneficial in the treatment of postpartum abdominal bulkiness in women.
REFERENCES
1. Erica P. Gunderson, Childbearing and Obesity in Women: Weight Before, During, and
After Pregnancy; Obstet Gynecol Clin North Am. 2009 June; 36(2): 317.
2. Colditz GA, Willett WC, Rotnitzky A, et al. Weight gain as a risk factor for clinical
diabetes mellitus in women. Ann Intern Med, 1995; 122: 481–6. [PubMed: 7872581].
3. Cash TF: Cognitive –Behavioural Perspectives on Body Image. In Body Image: A
Handbook of Science, Practice and Prevention. Edited by Cash TF, Smolak L. New York:
Guildford Press, 2011; 39-47.
4. Dhanashri Mahajan, Manish Bhoyar, Postnatal care in Ayurveda with special reference to
Sutika Paricharya. Ayurpharm Int J Ayur Alli Sci., 2: Pg-273-280.
5. Bhavamisra, Bhavaprakasha Samhita, Bramhasankara Misra, Chaukambha Sanskrit
Sansthan, Varanasi, Edition 5th
1993, Yoniroga Cikitsa Ch-70, Sloka No.130 ,Pg no. 788.
6. www.Wikipedia.org/wiki/Body_mass_index.
7. www.Whqlibdoc.who.int/publicatons/2011.
8. Peter J. Maud, Carl Foster, Physiological Assessment of Human Fitness,
www.books.google.co.in.
9. www.wikipedia.org/wiki/Sagittalabdominaldiameter.
10. www.wikipedia.org/wiki/Bodyfatpercentage.
11. Guidelines for Exercise Testing and Prescription: American College of Sports Medicine
in 2000, Philadelphia: Lea & Feiberger, 6th edition https://medanth.wikispaces.com/.
12. Gunderson EP, Abrams B, Selvin S. The relative importance of gestational gain and
maternal characteristics associated with the risk of becoming overweight after pregnancy.
Int J Obes Relat Metab Disord, 2000; 24: 1660–8. [PubMed: 11126221].
13. Gunderson EP, Abrams B. Epidemiology of gestational weight gain and body weight
changes after pregnancy. Epidemiol Rev., 1999; 21: 261–75. [PubMed: 10682262].
14. Billewicz WZ. Body weight in parous women. Br J Prev Soc Med, 1970; 24: 97–104.
[PubMed:5431074].
www.wjpr.net Vol 5, Issue 9, 2016.
1840
Neeraja et al. World Journal of Pharmaceutical Research
15. Gunderson EP, Murtaugh MA, Lewis CE, et al. Excess gains in weight and waist
circumference associated with childbearing: the Coronary Artery Risk Development in
Young Adults Study (CARDIA). Int J Obes Relat Metab Disord, 2004; 28: 525–35.
[PubMed: 14770188].
16. Institute of Medicine. Nutrition during pregnancy. National Academy of Sciences;
Washington, DC: 1990.
17. Rooney BL, Schauberger CW, Mathiason MA. Impact of perinatal weight change on
long-term obesity and obesity-related illnesses. Obstet Gynecol, 2005; 106: 1349–56.
[PubMed: 16319262].
18. Linne Y, Dye L, Barkeling B, et al. Weight development over time in parous women: the
SPAWN study–15 years follow-up. Int J Obes Relat Metab Disord, 2003; 27: 1516–22.
[PubMed: 14634683].
19. Gunderson EP, Sternfeld B, Wellons MF, et al. Childbearing may increase visceral
adipose tissue independent of overall increase in body fat. Obesity, 2008; 16(5): 1078–84.
[PubMed: 18356843].
20. Piers, et al., Changes in energy expenditure, anthropometry and energy intake during the
course of pregnancy and lactation in well-nourished Indian women. American Journal of
Clinical Nutrition, 1995; 61: 501-513.
21. Butte N, Garza C, Stuff JE, Effect of maternal diet and body composition on lactation
performance. Am. J. Clin. Nutr. 39: 296-306
22. Dr. K. C. Chunekar Commentary, Bhavaprakasha Nighantu, Reprint, Chaukhambha
Bharati Academy, Varanasi-221001, 2006; Sloka No. 64-65, Pg no. 19.
23. Shreya S. Shah, Gaurang B. Shah, Mehul Chorawala, Effect of piperine in the regulation
of obesity-induced dyslipidemia in high-fat diet rats. Indian J Pharmacol. 2011 May 2011;
43(3): 296-9.
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